What Is Medical Futility?

H. Tristram Engelhardt, Jr., PhD, MD, Professor of Philosophy at Rice University, wrote in his Oct. 23, 1996 article, "Rethinking Concepts of Futility in Critical Care," that was written for the Center for Medical Ethics and Health Policy at Baylor College of Medicine:

"Futility has been invoked as a concept to guide physicians in avoiding the provision of inappropriate care. The concept is complex and value-laden. It addresses a number of distinct concerns that are often confused, making the use of the term ambiguous, if not misleading.

Invocations of futility have often been used to avoid directly facing how one ought to incorporate considerations of chance of success, cost, life expectancy, and quality of life into decisions regarding what therapeutic options should be offered to patients and their families, how triage policies should be developed, how and when do-not-resuscitate orders may be written, and how access to high-cost, low-yield treatment may be limited."

The American College of Obstetricians and Gynecologists wrote in "Medical Futility," a chapter in its 2004 publication Ethics in Obstetrics and Gynecology:

"The construct of medical futility has been used to justify a physician's unilateral refusal to provide treatment requested or demanded by a patient or the family of a patient. Such decisions may be based on the physician's perception of the inability of treatment to achieve a physiologic goal, to attain other goals of the patient or family, or to achieve a reasonable quality of life.

Although there is general agreement with the notion that physicians are not obligated to provide futile care, there is vigorous debate and little agreement on the definition of futile care, the appropriate determinants of each component of the definition, or who should be the agents whose values determine the definition of futility. Proposed definitions of medical futility require 1 or more of the following elements:

The American Medical Association wrote in its policy E-2.037, entitled "Medical Futility in End-of-Life Care," (accessed on Aug. 18, 2006):

"When further intervention to prolong the life of a patient becomes futile, physicians have an obligation to shift the intent of care toward comfort and closure. However, there are necessary value judgments involved in coming to the assessment of futility. These judgments must give consideration to patient or proxy assessments of worthwhile outcome. They should also take into account the physician or other provider’s perception of intent in treatment, which should not be to prolong the dying process without benefit to the patient or to others with legitimate interests. They may also take into account community and institutional standards, which in turn may have used physiological or functional outcome measures.

Nevertheless, conflicts between the parties may persist in determining what is futility in the particular instance. This may interrupt satisfactory decision-making and adversely affect patient care, family satisfaction, and physician-clinical team functioning. To assist in fair and satisfactory decision-making about what constitutes futile intervention:

(1) All health care institutions, whether large or small, should adopt a policy on medical futility; and

(2) Policies on medical futility should follow a due process approach..."